[Therapeutic drug monitoring of antipsychotic drugs in routine psychiatric practice]

by Selleckchem | Oct 01 2023

Objective: To evaluate the relationship between daily doses of antipsychotic drugs, their serum concentrations, and characteristics of patients treated for schizophrenia or schizophreniform disorder in day-to-day clinical practice.

Material and methods: A total of 187 patients were included in the study, 77 (41.1%) patients were on monotherapy, and 110 (58.9%) patients received two or more antipsychotics. Patients age was 27.8±8.1 years, and their body weight was 79.8±15.6 kg. The sample was represented mainly by young men (93.0%). The proportion of smokers was 37.4%. The appropriate HPLC-MS/MS method was used for the simultaneous analysis of 8 antipsychotics and its active metabolites. Serum concentrations of the drugs aripiprazole (ARI), chlorpromazine (CPZ), haloperidol (HAL), zuclopenthixol (ZUC), clozapine (CLO), risperidone (RIS), quetiapine (QUE), olanzapine (OLA), norclozapine (N-desmethylclozapine, NOR), 9-hydroxyrisperidone (9-OH-RIS), dehydroaripiprazole (DGA) were measured. The serum concentration/dose ratio (C/D) was employed as the primary outcome measure, as doses were not kept constant during the study. The active antipsychotic fraction (drug+active metabolite, active moiety - AM) was also evaluated for RIS and ARI. In addition, the metabolite/parent ratio (MPR) was evaluated for RIS and ARI.

Results: A total of 265 biological samples were obtained, 421 and 203 measurements of the concentration of drugs and their metabolites were carried out, respectively. Overall, 48% of antipsychotics levels were in the expected therapeutic ranges, 30% were below therapeutic ranges, and 22% were above them. A total of 55 patients underwent dose adjustments or drug changes due to ineffectiveness or side-effects. It has been found that smoking reduces the level of C/D for CLO (p<0.01, Mann-Whitney test). We have established that comedication with CLO significantly increases the C/D ratio of QUE (p<0.05, Mann-Whitney test). We have not revealed any influence of weight and age of the subjects on the C/D. The dose-concentration regression relationships are formalized for all AP.

Conclusion: Therapeutical drug monitoring (TDM) is an essential tool to personalize antipsychotic therapy. Careful analysis of TDM data can contribute significantly to the study of the impact of individual patient characteristics on systemic exposure to these drugs.

Comments:

Abstract: The objective of this study was to evaluate the relationship between daily doses of antipsychotic drugs, their serum concentrations, and patient characteristics in the treatment of schizophrenia or schizophreniform disorder in day-to-day clinical practice. A total of 187 patients were included in the study, and serum concentrations of eight antipsychotics and their active metabolites were measured using an appropriate analytical method. The primary outcome measure was the serum concentration/dose ratio (C/D), and the active antipsychotic fraction (active moiety - AM) was also evaluated for specific antipsychotics. Additionally, the metabolite/parent ratio (MPR) was assessed for certain medications. The results showed that 48% of antipsychotic levels were within the expected therapeutic ranges, while 30% were below therapeutic ranges, and 22% were above them. Dose adjustments or drug changes were made in 55 patients due to ineffectiveness or side effects. Smoking was found to reduce the C/D ratio for clozapine, and comedication with clozapine increased the C/D ratio of quetiapine. No significant influence of weight and age on the C/D ratio was observed. The study highlights the importance of therapeutic drug monitoring (TDM) in personalizing antipsychotic therapy and emphasizes the value of analyzing TDM data to understand the impact of individual patient characteristics on drug exposure.

Keywords: antipsychotic drugs, schizophrenia, therapeutic drug monitoring, serum concentration, dose, active metabolites, patient characteristics